Wrinkles wrangled. Tummies tucked. Faces reborn. Plastic surgeon Dr. Steven R. Cohen is in the miracle-worker business, and business at his La Jolla cosmetic-surgery practice is very good. But for the 59-year-old doctor, teacher, artist and philanthropist, it is the work he does for free that makes the real magic happen.

As a volunteer at the Fresh Start Clinic at Rady Children's Hospital, Cohen performs complicated procedures on young patients at no charge. For the boys and girls who have had tumors removed, cleft lips repaired and faces reshaped, Fresh Start is the place where new lives begin. For Cohen, it is the place where his life just keeps getting better.

“For me, the reward is the pleasure of helping and using skills that I’m amazed that I even have,” Cohen said during an interview in his office, where he had just wrapped up a long phone consultation about a Fresh Start patient. “I have always wanted to make a dent in life, and I am still motivated by that.”

Founded in 1991 by the late Dr. Dennis Nigro of San Diego, Fresh Start Surgical Gifts has provided free plastic surgery for more than 6,000 children from all over the world. Cohen helped Nigro establish a permanent clinic at Rady. Fresh Start opened in 2009.

The clinic is a state-of-the-art facility with a small paid staff and a squadron of volunteer surgeons, nurses, anesthesiologists and other medical personnel. Many generous professionals help make Fresh Start a haven for parents who can’t afford the transformative help their children need, but there is only one Dr. Cohen.

“It’s not only that he has skills far beyond most, but because he has a really special outgoing personality with the public,” said Shari Brasher, CEO of Fresh Start Surgical Gifts. “He brings in new donors and he recruits new doctors and patients. He even finds auction items for our benefits. That is what is so precious about him. We have many surgeons who volunteer their care, but he starts from the grass roots. I think he feels like he has a lot of excess to share, and he does it.”

In the beginning, being a doctor was not something Cohen did for himself. When a beloved uncle died in the middle of a thriving orthopedic-surgery career, Cohen remembers promising his grief-stricken grandmother that he would be the next doctor in the family. He was just a kid at the time, but the boy from Washington, D.C. took that promise all the way to the George Washington School of Medicine, and then to an internship at the Columbia-Presbyterian Medical Center in New York.

The plan was to be a heart surgeon. But when Cohen saw a TV documentary about pioneering craniofacial plastic surgeon Paul Tessier, his plan skipped a few beats.

“I was so blown away by the dramatic changes in both appearance and function in young adults with these massive abnormalities, I said to my wife, ‘I want to do this.’ It was sort of the road less traveled. It looked so amazing, I changed career directions.”